Metabolic and Bariatric Surgery in Adolescents: For Whom, When, and How?

Abstract

Severe obesity in adolescence profoundly impacts health and social wellbeing. Lifestyle modifications are seldom successful in maintaining sufficient weight loss to mitigate the risk of complications. Metabolic and Bariatric surgery (MBS) is a standard treatment for adult patients and has emerged as an option for adolescent patients. Several high-quality studies of adolescent MBS show substantial and sustained improvements both in weight and cardiometabolic parameters, as well as a safety profile similar to that seen in adult patients. Patients report improvements in health- and weight-related quality of life. Concerns around adolescent MBS can be attributed to a fear of side-effects on growth and puberty, risk of nutritional deficiencies and osteoporosis, alcohol abuse, psychosocial vulnerability, and the ability to consent in the decision process. Guidelines give somewhat different recommendations, but the most comprehensive guidelines from the American Society for Metabolic and Bariatric Surgery recommend MBS for class III obesity or class II obesity with comorbidity. This mini-review aims to present published data on MBS in adolescents. We discuss indications for MBS and the optimal timing in the young person´s life, the choice of surgical method, and MBS in relation to the new anti-obesity medications. Based on data primarily from the USA and Sweden, we conclude that MBS is a valuable treatment option for adolescents with severe obesity that appears under-utilized against the backdrop of the poor prognosis of severe obesity. We argue for continued research, development of guidelines, multi-professional teamwork, long-term follow-up, and centralization of adolescent MBS.

Adolescents’ and professionals’ experiences of metabolic and bariatric surgery and requirements for preoperative and postoperative support through mHealth: a qualitative study

“…Metabolic and bariatric surgery (MBS) provides effective treatment for severe obesity and related comorbid diseases, and is increasingly recommended as a treatment option 17 18. Surgery is, however, restricted to patients who fulfil certain criteria: age ≥15 years and body mass index (BMI) ≥35 kg/m 2 with comorbidities or BMI ≥40 kg/m 2 for patients without comorbidities in accordance with international guidelines 19 20. In Sweden, the number of MBS carried out on adolescents (between 15 and 18 years) have varied between 29 and 66 MBS/year since 2010.…”

The Swedish Youth with Obesity cohort: Profile of an ongoing prospective study

“…Such issues may be mineral deficiencies or disordered eating. Other goals of the pre‐surgery program are increased insight into the necessary long‐term commitment with vitamin and mineral substitution and lifestyle changes [14]. The criteria for referral to bariatric surgery, apart from inability to achieve a healthy weight loss by previous weight loss attempts, is BMI ≥ 40 or BMI ≥ 35 together with at least one obesity‐related comorbidity for at least 2 years.…”

“…Such issues may be mineral deficiencies or disordered eating. Other goals of the pre-surgery program are increased insight into the necessary long-term commitment with vitamin and mineral substitution and lifestyle changes [14]…”

A Critical Review of Upcoming New Therapeutic Options in Paediatric Endocrinology

“…In severely obese patients non-responding to lifestyle changes and pharmacological therapy, bariatric surgery is a well-established procedure in adults. Janson et al [8] offer convincing arguments for bariatric surgery as a valuable treatment option also for adolescents with severe obesity and provide guidelines for implementation of such procedure in clinical practice.…”